Ultrasonic diagnosis of biliary atresia: A retrospective analysis of 20 patients

AIM: To investigate the clinical value of ultrasono-graphic diagnosis of biliary atresia (BA), a retrospective analysis of the sonogram of 20 children with BA was undertaken. METHODS: Ultrasonography (US) was performed in 20 neonates and infants with BA, which was confirmed with cholangiography by operation or abdominoscopy. The presence of triangular cord, the size and echo of liver, the changes in empty stomach gallbladder and postprandial gallbladder were observed and recorded. RESULTS: The triangular cord could be observed at the porta hepatis (thickness: 0.3-0.6 cm) in 10 cases. Smaller triangular cord (0.2-0.26 cm) can be observed in 3 cases. The gallbladder was not observed in 2 cases, and 1 case showed a streak gallbladder without capsular space. The gallbladders of 15 cases were flat and small. The gallbladders of 2 cases were of normal size and appearance, however, there was no postprandial contraction. The livers of all cases showed hepatomegaly and hetreogeneous echogenicity. Statistical analysis was performed to compare the hepatomegaly and hetreogeneous echogenicity and the stage of hepatic fibrosis. CONCLUSION: The presence of the triangular cord atthe porta hepatis is specific. However, it is not the only diagnostic criterion, since flat and small gallbladder and poor contraction are also of important diagnostic and differential diagnostic significance. The degree of hepatomegaly and hetreogeneous echogenicity is proportional with liver fibrosis, and able to indicate the duration of course and prognosis.

Effect of uninterrupted dabigatran or rivaroxaban on achieving ideal activated clotting time to heparin response during catheter ablation in patients with atrial fibrillation

BACKGROUND Uninterrupted use of oral anticoagulants before atrial fibrillation(AF)ablation can reduce the incidence of perioperative thromboembolic events.However,the effect of new oral anticoagulants on activated clotting time(ACT)in respo-nse to heparin during AF ablation in Chinese populations remains unknown.The aim of the present retrospective study was to investigate the value of ACTs in response to intraoperative heparin administration in patients using dabigatran or rivaroxaban.METHODS From January 2018 to December 2021,a total of 173 patients undergoing AF ablation were included in the study,in which 101 patients were treated with dabigatran,72 patients were treated with rivaroxaban.The intraoperative ACT values were examined in both groups.The incidence of periprocedural complications was evaluated.RESULTS Initial heparin dosage(88±19 U/kg vs.78±27 U/kg,P<0.05),total heparin dosage(137±41 U/kg vs.106±52 U/kg,P<0.05)during the ablation procedure were higher in the dabigatran group than those in the rivaroxaban group.Mean ACT(280±36 s vs.265±30 s,P<0.05),and the percentage of ACTs within the therapeutic range(250-350 s)(74%±26%vs.60%±29%,P<0.05)were significantly lower in the dabigatran group than those in the rivaroxaban group,particularly in male pati-ents.Furthermore,the average time of achieving the target ACT(250-350 s)was also found longer in the dabigatran group(P<0.05)as compared with the rivaroxaban group.No significant difference was found in the incidence of periprocedural complica-tions between the two groups.CONCLUSIONS The anticoagulant effect of uninterrupted rivaroxaban therapy appears to be more stable and efficient than dabigatran administration during catheter ablation in patients with AF.

Performance of the(BMAP_1, BMAP_2 )/(PH_1, PH_2 )/N Retrial Queueing System with Finite Buffer

This paper consider the （BMAP1, BMAP2）/（PH1, PH2）/N retrial queue with finite-position buffer. The behavior of the system is described in terms of continuous time multi-dimensional Markov chain. Arriving type I calls find all servers busy and join the buffer, if the positions of the buffer are insufficient, they can go to orbit. Arriving type II calls find all servers busy and join the orbit directly. Each server can provide two types heterogeneous services with Phase-type （PH） time distribution to every arriving call （including types I and II calls）, arriving calls have an option to choose either type of services. The model is quite general enough to cover most of the systems in communication networks. We derive the ergodicity condition, the stationary distribution and the main performance characteristics of the system. The effects of various parameters on the system performance measures are illustrated numerically.